Evolving burden and consequences of frailty in patients with acute myocardial infarction: evidence from a nationwide cohort.
Frailty is common in acute myocardial infarction (AMI), but evidence gaps may cause care disparities and worse outcomes. We examined the prevalence of frailty, its impact on care and its long-term effects.
We analysed adults hospitalised with AMI in England and Wales (2005-19) using linked registries. Frailty was classified by the Secondary Care Administrative Records Frailty (SCARF) index as fit, mild, moderate or severe. The primary outcome was 1-year all-cause mortality; secondary outcomes included cardiovascular death, Major adverse cardiovascular events (MACE), heart failure readmission, reinfarction and bleeding.
Of 931 133 patients (median age 70 years, 34% female), 13% had severe frailty, 22% moderate frailty, 36% mild frailty and 29% were classified as fit. Compared with fit patients, those with severe frailty were less likely to receive coronary angiography (44.8% vs. 69.3%), dual antiplatelet therapy (75.5% vs. 93.4%) or referral for cardiac rehabilitation (71.8% vs. 89.7%). Frailty demonstrated a graded association with 1-year mortality: aHR:3.01 (95% CI:2.93-3.10) for severe frailty, 2.33 (95% CI:2.27-2.40) for moderate and aHR:1.65 (95% CI:1.61-1.7) for mild frailty. Similar dose-response patterns were seen for cardiovascular death (aHR:2.82, 95% CI:2.70-2.94; 2.03, 95% CI:1.88-2.20; and 1.12, 95% CI:1.08-1.16), MACE (aHR:2.56, 95% CI:2.51-2.60; 1.84, 95% CI:1.80-1.89; and 1.17, 95% CI:1.15-1.19), heart failure readmission (aHR:3.74, 95% CI:3.61-3.88; 2.79, 95% CI:2.69-2.89; and 1.79, 95% CI:1.73-1.85) and major bleeding (aHR:1.85, 95% CI:1.78-1.92; 1.59, 95% CI:1.51-1.67; and 1.27, 95% CI:1.20-1.34).
In this national cohort, over one-third of AMI patients had moderate or severe frailty, which was associated with reduced use of evidence-based care and worse outcomes.
We analysed adults hospitalised with AMI in England and Wales (2005-19) using linked registries. Frailty was classified by the Secondary Care Administrative Records Frailty (SCARF) index as fit, mild, moderate or severe. The primary outcome was 1-year all-cause mortality; secondary outcomes included cardiovascular death, Major adverse cardiovascular events (MACE), heart failure readmission, reinfarction and bleeding.
Of 931 133 patients (median age 70 years, 34% female), 13% had severe frailty, 22% moderate frailty, 36% mild frailty and 29% were classified as fit. Compared with fit patients, those with severe frailty were less likely to receive coronary angiography (44.8% vs. 69.3%), dual antiplatelet therapy (75.5% vs. 93.4%) or referral for cardiac rehabilitation (71.8% vs. 89.7%). Frailty demonstrated a graded association with 1-year mortality: aHR:3.01 (95% CI:2.93-3.10) for severe frailty, 2.33 (95% CI:2.27-2.40) for moderate and aHR:1.65 (95% CI:1.61-1.7) for mild frailty. Similar dose-response patterns were seen for cardiovascular death (aHR:2.82, 95% CI:2.70-2.94; 2.03, 95% CI:1.88-2.20; and 1.12, 95% CI:1.08-1.16), MACE (aHR:2.56, 95% CI:2.51-2.60; 1.84, 95% CI:1.80-1.89; and 1.17, 95% CI:1.15-1.19), heart failure readmission (aHR:3.74, 95% CI:3.61-3.88; 2.79, 95% CI:2.69-2.89; and 1.79, 95% CI:1.73-1.85) and major bleeding (aHR:1.85, 95% CI:1.78-1.92; 1.59, 95% CI:1.51-1.67; and 1.27, 95% CI:1.20-1.34).
In this national cohort, over one-third of AMI patients had moderate or severe frailty, which was associated with reduced use of evidence-based care and worse outcomes.
Authors
Antoun Antoun, Mohiaddin Mohiaddin, Mccann Mccann, Lawson Lawson, Khan Khan, Ahmed Ahmed, Ng Ng, Murphy Murphy, Wijeysundera Wijeysundera, Rashid Rashid
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